The Clinical Prior Authorization (PA) Program was implemented to improve quality and manage drug classes that have been identified as requiring additional monitoring. This program is also intended as a means of ensuring that drugs are being prescribed for the right patients and for the appropriate reasons, while still monitoring drug expenditures.

Requests for prior authorization must be initiated by the prescriber and may be initiated via phone, fax or mail. The Magellan Medicaid Administration phone number is (866) 675-7755 and the fax number is (888) 603-7696.

How are the clinical criteria determined?

The Drug Use Review (DUR) Board recommends the specific clinical criteria. The DUR is composed of practicing pharmacists and physicians.

How often are the drugs and clinical criteria reviewed?

DHHS periodically reviews the drugs and the clinical criteria. Updates to the list of drugs and the clinical criteria are made in accordance with current clinical practices.